Archives

Another Sigh of Relief

I’m not a superstitious person at all (give me a mirror to break, and I will!), but as we approached our 10am ultrasound today, I started to get nervous. The last two Fridays with my successful ultrasounds, the day was sunny and mild. Cupcake stayed with a friend, I was having a good hair day, and I had my ultrasounds in the same room. Today? Rain and wind. An absolutely miserable day. Cupcake had to come along with me, too, and I could not get my hair to lay flat, and I learned that my ultrasound would be in a different room. To me, this spelled doom. All I wanted was to replicate the same set of circumstances that would *ensure* another successful u/s and I couldn’t. I felt panicky.

But alas, it was all for naught. I did end up in the same cozy u/s room with my favorite sonographer and Skittle’s heart was pounding away at a perfect rate of 170. The little one continues to measure ahead at 8w5d (I’m 8w1d today) and I couldn’t be more relieved or happy. All is well. And it’s a good thing, too, considering that’s it’s Honey’s and my 7th Dateversary — that is, the anniversary of our first date. What a sad celebration it would have been if things had gone the other way.

And I know things can still go south. Technically, once reaching 8 weeks, the miscarriage risk declines to 3% (according to the research I’ve read), but we all know people who have fallen on the sad side of this statistic. I still have worries, fears, and trepidations. But I am also feeling more optimistic and more hopeful than I have in so long. I am starting to plan for an October 3rd due date. There are still plenty of things I won’t be doing for a few more weeks, but I will be giving my sister the news this weekend. And I may start reading my week-by-week (or day-by-day or month-by-month) pregnancy books soon. And right now? I’m off to buy a doppler. So I have something new to obsess over, of course!

Wishing you all a happy weekend. And for those of you who are interested…the Skittle page is now up and running. XO

Advertisements

All is Well in the Dash Home

This morning, as I drove to the fertility clinic, I somehow convinced myself that Skittle was probably dead. I had not felt any pregnancy symptoms for the day yet and there was dread in the pit of my stomach. As I waited for my favorite sonographer (yay!) to come into the room, I felt sick. And no, I don’t think it was morning sickness. I’m fairly certain it was nerves. I was scared to death, perhaps more than I’d ever been so far. Which is saying something. I just knew they were going to tell me my baby was gone.

Thankfully, I was wrong. Completely. There was a heartbeat — a strong, beautiful heartbeat — with a heart rate of 153. Over 120 is normal at 7 weeks, but according to my sources on Google Scholar, 146+ is ideal. So I’m very pleased with 153. Today I am 7w1d and Skittle is now measuring 7w5d, which is a relief. We have officially passed the point where we lost Teddy Graham, which is one more small step forward. I am beginning to think maybe, just maybe, this baby will actually come to be. I know there is still so far yet to go, and anything can happen at any time, but for now we are planning on an early October due date.

Holy crap.

I return next Friday for one last ultrasound (my request, not their suggestion) before “graduation.” My RE has been urging me to make an appointment with my OB, so I finally bit the bullet and did that today after my successful u/s. I will be seeing him for the first time on March 5, when I will be almost 10 weeks.

If next week’s u/s is as successful as this one, I have three goals:

  • Start shopping for an at-home doppler in the hopes that it may help my sanity in between the monthly OB appointments.
  • Deliver the news to my sister. You all know there will be a post to come about that!
  • Make a “Skittle” page on this blog, where I will post the photos I’m collecting. And maybe start bumpdates. Maybe, maybe, maybe.

None of this feels quite real yet. Especially because Skittle seems to have come out of nowhere, when I least expected it. But every day, I fall in love with this baby, and the idea of this baby, a little more. And if next week’s u/s doesn’t go well? I do think that will be the end of the world.

Happy Tears

I have not cried over this pregnancy or baby yet, not from fear or joy, but today — when I saw the heartbeat — I did. Tears fell from my eyes before I even knew they were there.

So far, everything looks fantastic. I am much earlier in this pregnancy than I had thought, with baby only measuring at 6w1d today, but there was a strong heartbeat of 120bpm, which the nurse practitioner (who did my u/s) was very happy with. She says, at six weeks, they look for anything over 80 (online research says 100), so 120 is excellent by all accounts. The gestational sac is measuring at 6w6d, which I was assured is nothing to worry about. I didn’t ask about the size of the yolk sac because I didn’t want one more thing to obsess over, but both the NP and my doctor (who came in to talk with me after) said several times that everything looks perfect. They gave me a picture afterwards, one in which the baby really does look like a delicious white Skittle, and it is hard to believe they can see anything when the baby is that small, but I am trusting they know what they’re talking about.

Of course, being this early, it still means we have a long way to go. The next two weeks will be the highest risk of a miscarriage and then it improves from there. I still have a week before I reach the 7w1d mark when I started bleeding in my last pregnancy, but thankfully I do have my next ultrasound scheduled for exactly that day. Hopefully, it will bring nothing but more good news.

In the time since walking out of the clinic, though, I have had plenty of time to worry myself over lots of little things:

  • If I really am only 6w1d, that means my beta was tested when I was 4w6d. At that time, my level was over 10,000, which is extraordinarily high for being so early. What does this mean??? I questioned my doc about it and she said once the beta levels get to be over 1000, they fail to really provide accurate information for dating the pregnancy and everyone metabolizes the hormone differently, so it’s nothing to worry about. “Please don’t google it,” she told me because she knows me so well. But what if it means that something is chromosomally wrong with the baby? Or that I’m actually farther along than they think and the baby is measuring behind? That’s a scary thought.
  • Along the same lines of thinking…the gestational sac is measuring 6w6d while baby is only measuring 6w1d. What if Baby is, again, measuring too small?
  • If I ovulated on January 8, like they think I did based on the size of the little Skittle, that was CD32. But the last time Honey and I had sexy time was CD29. I know it’s possible for his little swimmers to hang around that long, but is it likely? In case you can’t tell, I’m just worried that we have the conception date wrong and Baby isn’t measuring on track.

I don’t know…what do you guys think? Do I need to worry? Or do I just need to take a deep breath and trust the professionals? I’m trying so hard to avoid Google because it brings so many doubts, questions, and worries into my life, but I don’t want to go to next Friday’s ultrasound thinking everything is fine if it’s not.

It’s hard because, with both of my last pregnancies, I never had blood work done and I never saw a heartbeat this early. I never saw one at all with Teddy Graham, but since he was measuring exactly seven weeks when I started bleeding, there probably had been one at some point. Maybe it was slow, maybe not. The problem is…I have nothing to compare this pregnancy to. Maybe that’s good. Maybe it will lead to less obsessing, but I sure would like some reassurance right about now.

But today, I am just trying to enjoy the sense of relief, joy, and hope that seeing that tiny flicker of a heartbeat has brought. I’m trying to focus on the fact that the heart is beating at a fantastic 120 that shows no indication of impending doom. I’m trying to believe that this is all only good news and I am worrying for nothing as I so often d0 and that this year is going to be more beautiful than I could ever have predicted. Please oh please, let that be true.

A La Dr. Young

I had a successful appointment with my RE this afternoon. I went there feeling jittery with nerves. I was expecting to leave feeling discouraged, after hearing nothing but gloom and doom and being told that our only hopes of conception are IUI or, worse, IVF. I got none of that.

We came up with a plan going forward, which I’ll get to in a minute, but first, we talked about plenty of other things. A *quick* summary:

  • Dr. Young thinks it’s probably wise to quit taking all the vitamins that we are on as they aren’t well regulated and there is not solid research proving that they are beneficial for reproduction. She thinks the only ones to continue with are the prenatal, omegas, and vitamin D (because of the climate we live in).
  • She would advise me to discontinue baby aspirin until after my BFP. I am young and healthy, so it is unlikely that I’ll develop an ulcer or bleeding issues from the aspirin, but it’s still possible and she always likes to error on the side of caution.
  • She will gladly prescribe progesterone suppositories, but she stressed the importance of taking them at the right time in my cycle. If I am being monitored and doing a trigger shot, I can take them three days after ovulation. If I am just predicting date of ovulation by OPKs, she wants me to wait a week just to be on the safe side.
  • She reviewed my 2009 2 hour glucose tolerance test. One value was abnormal and had me worried about possible insulin resistance, but she doesn’t think one abnormality is a concern. She would still recommend stopping the Metformin (I have been reluctant to thus far). She says she used to give it out like candy ten years ago, but after a study was done with Metformin and Clomid proving only a very few people benefit from it (by ovulating) in taking only Met, she thinks it’s unnecessary and worries about long-term safety.
  • Dr. Y reviewed my husband’s semen analysis with us and says his motility and count are excellent (which we already knew). The morphology is a concern and some doctors would automatically recommend IVF, but she says she’s not one of them. In a perfect world (where cost and time aren’t a consideration), she would say go with IVF w/ ICSI because it would give us our best chance. I’d probably be pregnant in a month or two, she predicted. But with the amount of money and time that must be invested in an IVF cycle, and with our prior two successes (BFPs), she doesn’t think it’s warranted yet. Nor is IUI. She wants to continue on the same road we have been.
  • She is billing my insurance under “PCOS” and “irregular periods,” but she did warn me that the insurance company can do with that information as they want. They could still deny coverage if they find out I’m taking Clomid. Fingers crossed that they don’t decide to be jerks about this!

Basically, from all of this, I got that my doctor is conservative in the drugs/supplements she encourages and describes, and likes things to be as simple as they can be. I respect that and I respect her. She’s got fantastic bedside manner, is open to all questions, and I appreciate that she seems well-read and well-informed. I truly trust her. However, that does not mean I necessarily agree with every recommendation. At this point, I’m going to continue baby aspirin and Metformin. I’m just too scared to quit right now. But I will re-evaluate the vitamins we’re taking and start with progesterone suppositories — but next cycle. This one, since I don’t have much hope for it and it’s already 9dpo, I’m just going to relax and take things easy.

And now for the plan… When my period comes, we will try 150mg (instead of 100) of Clomid in hopes that it may help my body to respond and ovulate sooner than CD20+. There is a greater chance of side effects, none of which I am particularly concerned about except possibly the elevated risk of cysts (because I’ve had them in the past) and the thinning of my lining. However, my last u/s (on CD16) showed a multi-layered lining of 11.5 (and that was after many months of Clomid), so Dr. Y is very encouraged that it may not affect me too much. And if the 150mg doesn’t work? We’ll do a combo cycle with Clomid (or Femara?) and an FSH shot.

I am pretty comfortable and happy with this plan. We’re moving forward, trying something new, but not doing anything too drastic. I’m slightly freaked out by taking Clomid for so many cycles and about the cost of the FSH and about giving myself an injection (eek!), but one day at a time, right? One step at a time. Breathe in. Breathe out.

Once Upon an RE…

As many of you know, I went to to visit an RE for my very first time on Friday. It was a frantic morning because they had to move my appointment to the 8 a.m. slot at the last minute, which meant waking my daughter an hour before she usually gets up and making an hour-and-a-half commute to get there in rush hour traffic. We had to park a block away and ran to the office (and I did not wear running shoes!). We arrived three minutes late, which I really hated and it left me feeling out of breath…which would probably explain why my blood pressure was 150/88 when the pregnant (of course!) medical assistant took it (it’s usually around 110/70). Ugh.

But the appointment went well, for the most part. My doctor, whom I will call Dr. Young because she is (late 30s? early 40s?), is straight-forward, easy to talk to, and open to questions. Since I’ve only spent an hour with her so far, it’s hard to have a real opinion, but I think I will like her and feel comfortable with her and I certainly do have confidence in her expertise. And surprisingly, she is in agreeance with much of what my OB/GYN, Dr. Smiles, already told me, which was unexpected but reassuring. We talked about a lot in the time that we spent with her, so please forgive me if this isn’t organized well. I think I’ll do it with bullet points (to at least give the illusion of organized thought):

  • PCOS: Yes, she thinks I have it. She says I am not a “classic” PCOS patient in appearance or labs, but she diagnoses PCOS through the process of elimination (every doctor has different criteria, I have found…I’ve seen four different doctors and they’ve all told me something different!). When someone has irregular periods, she rules out thyroid disorders (check!), prolactinemia (check!), and perimenopause (check!). If someone has no signs of those but doesn’t ovulate regularly, then she diagnoses PCOS. And it’s possible that the only sign of PCOS could be irregular cycles. So yeah…I guess that means I join the PCOS Club. Officially. My biggest fear in being diagnosed with PCOS was the high risk of miscarriage, but she assured me (just as my OB did) that there is no connection between the two. The studies that linked them were old and did not take into account diabetes and severe insulin resistance (which can cause miscarriage). If you exclude diabetics from the studies, the miscarriage risk would have been proven to essentially be the same as anyone else. So that was a relief to hear. I know there will be differing opinions on this, as Dr. Young reminded me there always will be, but I’m choosing to believe what she’s telling me. I need to believe for my own peace of mind.
  • Metformin: This is not a drug she prescribes, unless someone is clearly insulin resistant. Recent studies have shown that there is no proven benefit in helping with ovulation and she is hesitant to prescribe any drug that isn’t proven to be useful and has no long-term studies about it’s safety. I asked her if I should stop taking it and she says she thinks I should because, while I am lucky to suffer no GI side effects, there is the potential for liver and kidney problems…they’re rare but possible. And after thinking it over, I think she’s right. I have been taking this drug for three months and haven’t seen one bit of change in my cycles. I’m not insulin resistant, so why take a drug that I probably don’t need? Even the pharmacist told me that I was taking a very high dosage when I picked up my prescription last month. So I think it’s time to quit. I’ll wean myself off of it over the next few weeks and be done. I’m a little nervous about that because I know some do believe that Metformin can lower m/c risk, but Dr. Y doesn’t and I have to keep reminding myself that I didn’t need it while pregnant with Cupcake, so I probably don’t need it now either. Right?
  • Blood work: I successfully completed all the preliminary bloodwork through my OB and my RE doesn’t think any of it needs to be repeated at this time. Yay! This also means there won’t be any delay in starting treatment. Go me for totally being on top of this!
  • Chances of success: She reminded me that, with every cycle, there is only a 25% chance of success. I was very lucky to conceive on my first Clomid ovulation with both Cupcake and Teddy Graham, but I can’t expect it to happen every time, so this process is going to require some patience on my part. While I may be growing tired of Clomid because it’s not “working” (i.e. no BFP), it is doing it’s job and producing an ovulation. Now, it’s just a game of wait and hope.
  • Semen analysis: My husband asked about having one done. Honey had one come back as normal two years ago, but Dr. Y doesn’t think it’s a bad idea to have a recheck and we agree, so we’ll go ahead with that. Last time, my hubs got to do his business at home and take it in afterwards, but this time he’ll be doing it at the lab, which I can tell he is uber-excited about. He’s so fantastic, though, and hasn’t complained for even one second. It will cost us $110, which seems like nothing compared to everything else.
  • Short luteal phase: Dr. Y does not think this is a problem for me. She considers a luteal phase too short if it is less than 9 days. My shortest one has been 10 or 11 days and she doesn’t feel this needs any treatment. I asked why sometimes my LP is so much shorter than it is in other cycles and she said it’s just based on different hormone levels produced for that particular ovulation. Hmmm…
  • Baseline scan: I had a meet ‘n’ greet with the dildo cam at the end of our visit. It was the first time I had ever had that done during my period and can I just say…ew, gross? It was really, really gross and I’m sure much more so for my doc, but she’s used to that, right?  Anyhoo…she did conclude that my ovaries look polycystic (with 10-12 visible follicles on one side and 12-15 on the other, when the most she should see is 10 and that’s in someone much younger than myself). Also — there are no ovarian cysts or visible uterine fibroids. Good news! She also determined that my lining got plenty thick in my last cycle because, when she measured it, it was 11mm…and that was on CD2, after a full day of bleeding. So Clomid isn’t causing problems with that at this point. More good news!
  • Progesterone levels: In September, my P4 was 11.0 at 8dpo. I was less than excited about that number, but the doc doesn’t think I have a reason to worry. She says she only orders a P4 test to see if someone has indeed ovulated (anything over a 3.0) or if she is concerned about a very, very short luteal phase. She never bothers with the actual number and doesn’t monitor it in her patients because she doesn’t think it provides enough information to be worth it. Which means she doesn’t think I need progesterone supplementation of any kind at this point. She did say, though, that a trigger shot will probably help my body to produce more progesterone.  Which leads me to…
  • Treatment: I asked about switching to Femara, but for now, Dr. Y wants to stick with Clomid. She says that “they” say you shouldn’t take it more than twelve times in your lifetime, and this current cycle will be number 12 for me, but she is willing to let me go two more after this one. She really wants to do a monitored cycle and a trigger shot for this round, to see how my body responds. So I’m scheduled for a scan on day 12 (Nov 12) and we’ll go from there.  Hopefully, I’ll be ready to trigger and then we wait. If not, I’ll have to return for another scan and keep doing so until I am ready for the shot. And if this cycle doesn’t end happily, we will do two more rounds of Clomid, of which I will have to decide if I want to do monitoring or not (not recommended, but allowed).  After that, I’m a bit confused about where we go from there. There was talk of Femara, IUI, and IVF, which raised my level of anxiety and panic to unknown heights. I do know there won’t be any injectables (maybe if I beg?) because, when combined with PCOS, the risk of multiples is just too high. I have a follow-up scheduled with Dr. Y for Dec. 4, where we will create a long-term treatment plan. Which scares me to death.

So I feel pretty good about most of this, but there are a few concerns I have:

  • I felt a bit rushed at the end of the appointment and had to speed through my final questions, which was a bit irritating. I know Dr. Y had a procedure to get to (which is why my appointment had to be moved up), but I’m a new patient and have a lot to talk about…don’t I deserve her time and focus while she is with me?
  • I’m not thrilled that I won’t be getting progesterone suppositories. Dr. Y doesn’t think I need them, which is great, but what if she’s wrong? I want a safety net. One thing that will let me breathe a little easier and say, “At least I don’t have to worry about that.” So I may push her on this a bit more down the road.
  • Monitoring and especially the cost of it. One u/s scan on day 12 and a trigger shot? I think we can afford that (definitely can if my insurance picks up any of the cost). But I am fairly confident in saying that I don’t believe I’ll be ready to trigger on day 12. I normally ovulate days 19-23…a whole week (or more) earlier than this seems too optimistic to me. Which means I’ll probably have to return for another scan. And what if I’m still not ready and have to go back for another? The costs will just keep climbing and, while we can do this for one month, I’m not sure it’s something we can do over the span of several. Not to mention the exorbitant time that will be required, especially with the holidays nearly here and with a toddler in tow. It takes at least an hour to get to my RE…and an hour to get home. That’s a lot of time, especially if I have to do it more than once a week.
  • Too much too soon. In other words, taking an approach that becomes too aggressive too quickly. I am willing to stick with Clomid or Femara for a good few months and maybe do monitoring and a trigger for those cycles. But to go straight from Clomid to IUI in just three months? That’s when I start to feel my panic rise. Because I know that IUI is the end of the road. There will be no IVF for us. This is not something I’ve discussed before because I haven’t thought I would need to, and it’s something I will explain more if it comes to that, but I just know that, right now, we have drawn the line there and IUI is the last stop. And so in three months, if Dr. Y wants to move on to IUI, it will be my final and only hope and that is just too scary. I am not ready to arrive there yet.

So over the last couple days, since meeting with Dr. Y, I’ve been feeling overwhelmed. Overwhelmed by the money and time all of this will require. And overwhelmed by the possibility that none of it may work. That the bills will pile up and it won’t be worth it in the end because I won’t have another baby. But as my mom keeps reminding me, I need to take it one step and one cycle at a time. Why worry about IUI in three or six months when this very cycle could be The One? So I’m taking lots of deep breaths, praying, and just trying to balance hope with expectations. Faith with realism. Not worrying about what hasn’t happened yet, and still preparing for the worst case scenario. It’s a very fine line.

And so there you all go…the story of the day I met my RE. Fascinating and heart-warming, isn’t it? So sorry about the neverendingness of it. I do promise you that one day — one day very soon! — I will publish a post that doesn’t take me three hours to write…or you a whole hour to read.